Validation of Nursing Outcomes Related to Breastfeeding Establishment

Purpose To clinically validate indicators of the nursing outcomes "Breastfeeding establishment: Infant (1000)" and "Breastfeeding establishment: maternal (1001)", and their conceptual and operational definitions in infants admitted to a neonatal unit and their mothers. Method This study utilized several methods in a stepwise approach including an integrative review of the literature, content validation, and clinical validation. The content validity index was performed by eight experts, who evaluated revised content of the studied nursing outcomes. In the clinical validation, 61 mother-infant dyads were evaluated by two pairs of nurses: one pair used an instrument with developed definitions, whereas the other used an instrument without definitions. The evaluations were compared using Fleiss' kappa and weighted kappa. Results The agreement between all evaluators was considered excellent for almost all nursing outcome indicators related to the mothers. The pair of evaluators using the definitions had an agreement greater than 0.80 for most indicators. For the pair that did not use the definitions, agreement was poor. Conclusion There was an increase in uniformity and accuracy between the assessments when using the conceptual and operational definitions for the nursing outcome indicators related to Breastfeeding establishment. Implications for nursing practice This study contributed to the development of terms within the Nursing Outcomes Classification, and enriched the body of nursing knowledge.